Augment + APV

Bladder Augmentation

Ileocecoplasty technique

  1. Place patient supine with arms out, place in trendelenberg, do not need to hyperextend bed, give cefazolin + metronidazole for bowel coverage
  2. Tip: can place foley prior to prep/drape, but need accessible to fill bladder during case
  3. Make midline incision from pubic symphysis to slightly above umbilicus to access hepatic flexure, divide layers and enter peritoneal cavity
  4. Free up ascending colon from retroperitoneal attachments, can see kidney/duodenum underneath, free up to hepatic flexure
  5. Mark 10-15cm terminal ileum and 10-15cm cecum/ascending colon, identify mesenteric blood supply to ensure presence, can perform doppler and IC green before stapling
  6. Create mesenteric window with tonsil/bovie, then divide mesentery up to bowel with ligasure, then staple bowel
  7. Take bowel ends, create opening and staple together (ensure new conduit is inferior), then close the hole either with new staple load or 2-0 vicryl interrupted, can oversew with 2-0 silks
  8. Fill bladder with 200mL water, then open bladder at dome transversely, place traction 2-0 vicryl stitches on flaps for access
  9. Ensure cecum lays comfortably on bladder, then open antimesenteric end of cecum
  10. Open end of ileum, place 12Fr catheter, grasp redundant tissue with allis clamps, and staple off excess ileum (taper off towards ileocecal valve)
  11. Switch for 16Fr catheter, place plication (imbricating) sutures with 2-0 vicryl on antimesenteric side, checking that catheter pops in/out after tying each one down
  12. Secure cecum to bladder with 2-0 vicryl - place 3 stitches and run each one, try to have knots on outside of bladder
  13. Place drain - make separate stab incision, then push tonsil clamp from skin into abdomen, grasp drain and pull through, secure with nylon stitch
  14. Cut out circle on skin at ideal channel site, remove underlying subcutaneous fat (expose with army/navy retractors), create small cruciate incision on fascia, should be large enough to allow one finger through
  15. Insert babcock clamp through channel incision into abdomen, grasp channel and bring out through skin, stitch to skin with 3-0 vicryl (do not stitch mesentery), make sure balloon is inflated, should have either separate suprapubic or urethral foley as safety valve
  16. Closure - #1 PDS x2 (meet in middle) for fascia, then 3-0 vicryl to bring subcutaneous tissue together and staples for skin